How common is BPH (benign prostate hyperplasia) and is it dangerous?

As we get older, our bodies don’t work as well as they used to. Many men may experience problems with urination, including having less control. This can be due to a condition of the prostate called BPH (benign prostate hyperplasia/hypertrophy). Experienced urologist Mr Tamer El-Husseiny is here to talk about how common this condition is and how new minimally invasive treatments can help.

How common is BPH?

Benign prostatic hypertrophy describes a common condition in ageing men whereby the prostate increases in size and may compress the urethra (the water-pipe) as it leaves the bladder. This ‘squeezing of the water pipe’ produces numerous urinary symptoms, such as urination problems, urinary tract infections (UTIs) and even renal failure.

Benign prostatic hyperplasia (BPH) with associated lower urinary tract symptoms (LUTS) is a common benign (non-cancerous) condition in the ageing male. The incidence has been estimated to increase from 50% among men between the ages of 50 and 60 years, to 90% for men older than 80 years of age.

In 2016, it was estimated that up to 3 million men in the UK had lower urinary tract symptoms suggestive of BPH.

Minimally invasive treatment for BPH 

A wide variety of treatments are available for an enlarged prostate, including medications, minimally invasive procedures and surgery. The best BPH treatment is a personalised approach, which takes several factors in to consideration, including:

• Your preference and expectations
• The size and shape of your prostate
• Your age
• Your overall health
• The amount of discomfort or bother you are experiencing

Traditionally, BPH treatment begins with making lifestyle changes for mild symptoms as well as taking medication. If the symptoms continues to be bothersome, surgical options such as laser prostate treatments (HoLEP) or the traditional TURP procedure could be considered. More recently, newer minimally invasive treatments have been introduced with minimal side-effects, such as Rezūm Water Vapour Therapy and Urolift.

Rezūm Water Vapour Therapy

Rezūm is a new minimally invasive treatment by which steam energy is used to ablate (shrink) the particular part of the prostate that has become enlarged and is causing symptoms.

Rezūm uses the natural energy stored in water vapour, or steam. It is a safe and effective treatment available to relieve symptoms associated with BPH.

Urolift

The Urolift is a new minimally invasive surgery that involves telescopic insertion of special implants to compress the sides of the prostate to relieve the pressure in the urethra and increase the flow of urine.

HoLEP (holmium laser enucleation of the prostate)

This operation involves the telescopic removal of obstructing prostate tissue using a laser. It utilises the holmium laser as a precise cutting instrument to enucleate the lobes of prostate blocking urine flow. The removed tissue can be examined to rule out prostate cancer.

What are the advantages of new BPH treatments over older treatments?

Rezūm Water Vapour Therapy

• Preserves sexual and urinary functions
• Day case procedure which is performed under local anaesthesia and sedation.

• A rapid return to normal activities
• Fast, effective and, precise BPH treatment
• Ablates targeted tissue, which is then resorbed
• Treats enlarged central zones and/or median lobes
• Clinically proven to be safe and effective

Urolift

• Does not compromise sexual function – normal ejaculation and sensation on ejaculation is maintained as well as no deterioration of erectile function.
• Works immediately; no three-month delay as with standard surgery – patients often describe improvements in 1-3 weeks.

• General anaesthetic may be avoided – a procedure under local anaesthetic alone is increasingly common.
• Typically no urinary catheter is required.
• Rapid discharge from hospital within hours of the procedure.
• A rapid return to normal activities (including work) in days rather than weeks and months, as may be the case after standard surgery.

HoLEP

• Suitable for large prostates
• Excellent improvement in symptoms.

• Less need for further future treatments
• Less bleeding - the coagulative ability of the holmium laser effectively seals tissue planes as the operation progresses, which makes HoLEP a relatively bloodless operation with a concomitant reduction in transfusion requirement. Also better option for patients on anticoagulants (blood thinning treatments).
• Shorter postoperative catheterisation period and hospital stay as compared to the traditional TURP procedure.
• The ability to retrieve tissue for histological examination to rule out prostate cancer.

Are there any negative side-effects to newer treatments?

Long-term side-effects are minimal with the newer minimally invasive treatments such as the Rezūm Water Vapour Therapy and Urolift. Many men are therefore preferring them over the traditional surgeries such as the TURP or even over medical treatments, which are sometimes not tolerated due to their side-effects.

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